Founded in 1906, McLeod Health is a locally owned and managed, not for profit organization supported by the strength of more than 900 members on its medical staff and more than 2,900 licensed nurses. McLeod Health is also composed of approximately 15,000 team members and more than 90 physician practices throughout its 18-county service area. With seven hospitals, McLeod Health operates three Health and Fitness Centers, a Sports Medicine and Outpatient Rehabilitation Center, Hospice and Home Health Services. The system currently has 988 licensed beds, including Hospice and Behavioral Health. The hospitals within McLeod Health include: McLeod Regional Medical Center, McLeod Health Dillon, McLeod Health Loris, McLeod Health Seacoast, McLeod Health Cheraw, McLeod Health Clarendon and McLeod Behavioral Health.  

Maintains a professional image and exhibits excellent customer relations to patients, visitors, physicians, and co-workers in accordance with our Service Excellence Standards and Core Values

 

 Answers telephone within three rings using good customer service skills to ascertain the nature of the call as needed. Uses proper telephone etiquette when receiving and transferring calls; speaks clearly and concisely.  Exercises tact and diplomacy Maintains confidentiality in talking with patients, upholding policies and setting an example. Schedules and reschedules appointments if needed. Uses exceptional customer skills when speaking with insurance companies/patients and other internal departments Keeps work area neat, clear of clutter. Works in with iPas system and monitors communications needs to assure timely responses Monitors email throughout the day Demonstrates a willingness to assist coworkers when workloads require Timely management of  prior authorization requests for all infusion services ordered through Florence and Seacoast Oncology and Hematology Offices Oncology and Hematology, radiology services as necessary, and other medical testing and procedures based on diagnosis and need Display advanced computer skills within programs such as Excel and Word and Internet use Review chart documentation to ensure patient meets medical policy guidelines Prioritize incoming authorization request according to urgency Obtain authorizations via payer website or by phone Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations Respond to clinic questions regarding payer medical policy guidelines Confirm accuracy of ICD diagnosis and corresponding J codes or CPT codes for orders Contact patients to discuss authorization status and obtain additional information as needed

 

Display ability to learn and retain basic medical terminology allowing proficient navigation and documentation within the electronic medical record  Maintain knowledge of up to date payor specific programs to ensure appropriate authorization  Assist with Cash Balancing procedures Other duties as assigned Job Requirements

Qualifications /Training:

 

Knowledge of prior authorization process and it’s impact on the practice’s revenue cycle Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively Basic understanding of oncology treatment approaches and radiology studies as relating to diagnosis and restaging Proficient use of J codes, CPT codes, ICD codes Excellent computer skills including Excel, Word, internet use, and electronic medical record systems Detail oriented with above average organizational skills Plans and prioritizes to meet deadlines Excellent customer service skills Clear and effective communication Ability to multi-task and remain focused while managing a high-volume, time sensitive workload

 

 

Licenses/Certifications/Registrations/Education:

Minimum of a High School Diploma/GED from an accredited school 2 years of experience in medical related field or completion of a medical based educational program preferred 2 years of medical prior authorization experience preferred